CQC spent over £13m rolling out inspection regime

Exclusive The CQC spent £13.3m on rolling out its ‘Ofsted-style’ GP inspections last year, Pulse can reveal, as the regulator has come under pressure to scrap the scheme from the BMA and the RCGP.

The figure was revealed in a Freedom of Information (FOI) request as part of an investigation by Pulse looking into the true costs of CQC inspections, which also found that practices were having to devote up to hundreds of staff hours on preparing for the inspections.

The CQC’s new inspection and regulation regime for general practice was announced as part of Professor Steve Field’s appointment as chief inspector of general practice in August 2013 and was fully rolled out in October 2014.

And the Pulse investigation found that the cost of the rollout has so far been £13.3m – which was under the £16.5m originally budgeted.

The investigation has also discovered that CQC fees could soon be set to double.

GPs currently pay around £6m for the inspections, but the Government has said that regulatory activities will soon have to become self-funding. If the annual costs of the inspection regime do not increase, this means that GPs will be having to double their contribution to cover the whole costs.

Currently, GP practices with a single location pay between £616 and £948, while those with more than one location range from £1,341 to £16,759.

The inspections – which give practices ratings of ‘outstanding’, ‘good’, ‘needs improvement’ and ‘inadequate’ – have faced a wave of criticism from the GP profession, with the GPC calling for it to be scrapped and the RCGP calling for an immediate halt in recent weeks.

Professor Steve Field, chief inspector of general practice at the CQC and a former chair of the RCGP, said about the college’s statement: ‘We are extremely disappointed that the Royal College of General Practitioners has called for an “emergency pause” to our inspections of general practices, which we carry out to make sure that people across England get safe, high-quality and compassionate primary care. The safety and quality of care of people who use these services continue to be our number one priority.

Originally published by Pulse.


QOF should be scrapped under ‘new deal’ for GPs, says RCGP

The RCGP is calling on the GPC to ‘replace QOF’, and has urged the Government to conduct an immediate review of the ‘unnecessary burden’ posed by CQC inspections in a bid to relieve the immense pressure on GPs.

In its ‘blueprint’ – which details how the Government can deliver on the Five Year Forward View to overhaul the NHS – the college calls for an ‘urgent full scale review into how the bureaucracy, red tape and unnecessary workload’ can be reduced and how to free up GP time to focus on ‘delivering high quality patient care’.

It says that the QOF is creating ‘unnecessary burdens’ on GPs, and says there should be new funding arrangements to replace it.

The RCGP also says that there should be an ‘immediate review’ of the role of the CQC, following the calls from the LMCs Conference to scrap the regulator, and aspeech by Dr Chaand Nagpaul calling for an end to the inspection regime.

The RCGP’s plan for general practice – released in May to coincide with the election of the new Government – stressed the safety implications of general practice being ‘significantly overstretched’, as GPs are unable to make necessary innovations to ensure future patient care.

It said: ‘There are concerns that general practice does not have the capacity to withstand a major health crisis such as a national flu outbreak, and that GPs who want to spend more time developing new models of patient care are prevented from doing so by current pressure levels.’

Originally published by Pulse.

This could partly be achieved by a review of QOF and the CQC, it said.

The report called for the Government to ‘immediately initiate discussions with the GPC to replace the QOF with a new funding arrangement that allows GPs more freedom to focus on providing the best possible holistic care to patients and eliminates unnecessary bureaucracy’.

The calls come after several CCGs have initiated moves to replace the QOF locally as part of plans to co-commission primary care, while health secretary Jeremy Hunt has said he would ‘scrap QOF if I could’.

The RCGP similarly called for an ‘immediate review of CQC inspections and regulatory processes to eliminate unnecessary burdens for  general practice, and to ensure that scrutiny is focussed in those areas where it is likely to have most beneficial impact’.

It follows similar calls by Dr Nagpaul, who said the Government must ‘end the punitive overregulation that’s suffocating general practice – among the top four reasons why GPs want to leave the profession.’

He told the LMCs Conference last month: ‘We managed to get rid of the shameful intelligent monitoring bands, but still have practice ratings without context and circumstance, and which misleads the public with crude proxies that demean the holistic care hard working GPs provide.’

The blueprint also revealed that later this year the RCGP will publish ‘recommendations looking specifically at the patient safety implications of the rise in GP workload levels and the associated dangers presented by GP fatigue’.

GP burnout puts Government’s seven-day NHS access plan at risk

Burnout poses a ‘significant’ risk of derailing the NHS efficiency drive and the move towards seven-day, a think-tank’s briefing to MPs said today.

The Nuffield Trust briefing – released ahead of a parliamentary debate on seven-day services today – says there needs to be a ‘step change’ in the way primary care services are delivered’, and says that ‘extended opening hours in a larger number of GP surgeries is.. a welcome aspiration’.

However, it highlights the ‘looming workforce crunch’ in general practice, caused by a ‘potential shortfall in GP numbers, real financial pressures and a growing primary care workload’, and says there must be change in this area.

The new Government has reiterated its ambition for a seven-day NHS, including primary care services, by 2020, despite widespread opposition from GPs.

The Nuffield Trust said it supported the Government’s aims, but added that ministers must address problems in the workforce first.

It stated: ‘Staff burnout is becoming a significant risk in many settings.

‘Politicians must think carefully about how to reconcile the need to develop and encourage the workforce with the inevitable political desire to maintain “grip” on the NHS when the financial situation continues to deteriorate. ‘

The briefing also said that there is a clear need to embrace change and extended opening hours in a larger number of GP surgeries is a ‘welcome aspiration’.

It said: ‘With general practice facing a looming workforce crunch caused by a potential shortfall in GP numbers, real financial pressures and a growing primary care workload, there is a clear need to embrace change.

‘Scaled-up general practice, better use of existing skills such as pharmacists or practice nurses, and developing innovative working arrangements with other health or social care providers in the area should all be pursued.’

Pulse recently launched its second major national survey of GP burnout. The original survey in 2013 revealed that almost half of GPs were at high risk of burnout.

Originally published by Pulse.

Third of patients want improved standard GP access

A third of patients are unhappy with access to GP appointments, a Monitor survey has claimed, which GP leaders have said demonstrates the need for more resources to be directed towards standard access.

The survey of 3,315 patients by the healthcare regulator found that 81% of patients were satisfied overall with their GP practice and a large majority of GP practices perform well against quality indicators used by commissioners and regulators, while 93% said their practice had a good reputation.

It also found that a large number (30%) said they found it difficult to get an appointment, 34% were unable to book online, while 35% could not get to see the same doctor.

Catherine Davies, executive director of cooperation and competition at Monitor, said: ‘Commissioners have the chance to help the NHS meet the needs of a growing and ageing population by improving access and capacity of GP services in England.’

Responding to the report, Dr Chaand Nagpaul, GPC chair, emphasised that the majority of patients are satisfied overall, and that the Government should focus on giving GP services the backing they need.

He said: ‘These findings support the BMA’s consistent message to politicians that GP services do not have the resources, staff or infrastructure to meet rising patient demand. Many GP practices are struggling to treat the sheer number of patients coming through their doors and deliver enough appointments.

‘Despite this, the Monitor report says that a substantial majority of patients are satisfied with their GP practice… This is down to the hard work of GPs and is despite the pressure they are under.

He added: ‘Instead of promising patients undeliverable services, ministers need to focus first on ensuring GP practices can actually deliver basic care to their local patient populations.’

Originally published by Pulse.